What really is Lyme disease – and how do you know if you have it?

A small percentage of tick bites can lead to Lyme disease. Here’s how to know if you have the condition, and how to treat it

If a stroll through a forest or meadow has left you with tiny hitchhikers latched onto your skin, be mindful. It’s not just the bites that are worrisome; these ticks carry with them the silent threat of Lyme disease, an infection that spreads with little warning.
Studies in Europe estimate that 1 to 5 per cent of tick bites can lead to the condition, and on average, around 4 per cent of ticks are infected in England and Wales (reaching as high as 8-10 per cent in some areas).
The bite, which can often go unnoticed, can unleash a list of symptoms including chronic tiredness, that can potentially linger for years.
And the ticks are not just confined to the Scottish borders or the wilds of Exmoor. 
“A tick doesn’t know if it’s in South London or the Scottish highlands. While we know it’s more densely populated in areas of forestry, it doesn’t mean you can’t pick it up in your back garden or local parks,” says Georgia Tuckey, an independent prescriber and nurse consultant specialising in tick-borne diseases at The Tick-Borne Disease Clinic. 
So how do you know if you have it, and what can be done to treat it?
“Lyme disease is a bacterial infection caused by the Borrelia burgdorferi bacteria and transmitted to humans through the bite of infected ticks,” says James Logan, a scientist and professor at the London School of Hygiene and Tropical Medicine
If untreated, Lyme disease can lead to more severe symptoms such as joint pain, facial paralysis, and neurological or heart problems. 
“It often starts with flu-like symptoms and a distinctive red, “bullseye” rash called erythema migrans,” says Prof Logan, “although not everyone develops the rash.”  
Tick bites typically appear as a small red dot which is slightly raised and can cause the skin around the area of the bump to look reddish in appearance, says Dr Ross Perry, the medical director of Cosmedics skin clinics. 
The bullseye rash can appear up to three months after being bitten by an infected tick and it can last for several weeks.
The rash can have a darker or lighter area in the centre and might gradually spread. It’s not usually hot or itchy.
“They can bite you anywhere on your body, but they do prefer warm moist areas such as armpits, groin area, back of your knees and around your waist,” explains Niamh McMillan, Superdrug’s pharmacy superintendent. “Keep a close eye on symptoms in the first few weeks after the tick bite.” 
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Early symptoms of Lyme disease usually happen within three to 30 days after a tick bite. This stage of disease has a limited set of symptoms. 
As well as (or instead of) a rash, people with early Lyme disease may experience any of the following:
More serious symptoms may develop several weeks, months or even years later if Lyme disease is left untreated or is not treated early on. These can include:
Rarer later symptoms can include:
If you suspect you have Lyme disease, ask your doctor for a blood test to help diagnose the disease. 
Tuckey says: “If a patient has an erythema migrans rash, you would go to your GP and try to receive a diagnosis. Some of the difficulty with diagnosis is when a patient with this rash has tested immediately, the body hasn’t produced any antibodies to identify the infection and instead produces a negative result.
“They’re told they don’t have Lyme disease despite having the rash that is purely diagnostic of Lyme.”
Only a very small percentage of people actually end up with symptoms. 
“The GP would ideally treat the patient with a course of antibiotics,” Tuckey says. “If symptoms do break through during the course of that treatment, or after completion of the treatment, the GP will go on to prescribe a further course of treatment for another three weeks. So it would result in six weeks of antibiotic treatment in total.”
Prof Logan says: “It can go away with treatment. When diagnosed early, it is usually treated with a course of antibiotics,  which can clear the infection. Most people who receive timely treatment recover fully and do not experience long-term complications.
“However, if Lyme disease is not treated in early stages, it can spread to other parts of the body, leading to more severe symptoms such as arthritis, neurological problems and other issues. In these cases more intensive treatments, including intravenous antibiotics, may be necessary. People may continue to have symptoms for a long time.”
To avoid being bitten by a tick, spray on insect repellent before you head out into the countryside and cover up with light, long-sleeved clothes. While you are out, stick to clearly defined paths, avoid brushing against vegetation, regularly check clothing or exposed skin, remove any attached tick as soon as you find it and on your return, do a quick body audit. 
What should you do if you find a tick?
Avoid using tweezers if possible. “Unless you know what you’re doing, only remove ticks using a special tick remover tool, available from pharmacists. Tweezers don’t work as well. You have to be careful taking a tick out as they can break, leaving parts still inside the body,” says Howard Carter, a bite prevention expert who oversees all incognito testing at the London School of Hygiene & Tropical Medicine. 
Remove gently and hold it so that it is vertically above your skin. “The chance of contracting Lyme disease is far less if you successfully remove the tick without squashing its innards into your body,” he adds. If you don’t have a tick remover, then use clean fine-tipped tweezers and avoid squashing the tick. Do not use any oil or nail polish.
What other illnesses is it often mistaken for? 
Tuckey says it is often mistaken for fibromyalgia, myalgic encephalomyelitis (ME) and chronic fatigue syndrome. “A lot of our patients have often gone through a plethora of investigations.”
Celebrities with Lyme disease
Even the rich and famous aren’t immune. From the world of comedy, Miranda Hart revealed her battle with Lyme disease, receiving her diagnosis after 33 years. Similarly, singers Justin Bieber and Avril Lavigne shocked their fans when they disclosed their struggle with the illness. Their stories are reminders that there is no immunity from the unpredictable grasp of Lyme disease, a condition that is elusive as it is relentless, affecting millions across the globe.
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